Benjamin Yu, MD, PhD is vice president of medical informatics and genomics at Interpreta of San Diego, CA.

A missing piece in population health is real-time data and its real-time and continuous analysis. It’s a key ingredient that can help streamline health delivery, improve outcomes, and manage a dynamic patient population. Real-time interpretation is a keystone in many service industries, especially finance and e-commerce. However, its value is often overlooked in healthcare.

Instead, the health industry typically relies on monthly or quarterly business reports to spotlight health needs (e.g., gaps in care, medication management, etc.) and to find regional deficiencies. Using this information, groups plan and carry out campaigns to target and improve care through a variety of outreach mechanisms such as care managers, call centers, and provider network contacts.

However, during the laborious process of assessing static reports, millions of conditions change. It’s analogous to using turn-by-turn instructions for driving based on outdated information. Normally, turn-by-turn directions help the driver navigate through unknown roads and emerging traffic conditions in real time. However, if the system is not current, it might alert the driver long after he/she has missed a turn.

Similarly, in healthcare, by the time an outreach takes place, the member’s medications may have changed, a new refill may have been missed, a vaccine or screening may have been completed without the knowledge of the campaign, or a patient could have become ill or hospitalized before discovery of his/her risk. Thus, in addition to being expensive, the discover-and-campaign approach can be disjointed and too slow to adapt to the ever-changing landscape of a patient population.

Despite their potential benefits, real-time clinical solutions have been hampered in population health for several reasons. Many groups fear that real-time clinical data means too many alerts. While this may be true of some clinical information systems, it is not inherently true. In fact, the opposite may be true in that one of the major efficiencies provided by real-time data is reduced noise.

Because data is up to date, resolved issues should quickly disappear from the clinical workflow. For example, when a health plan calls a patient, instead of reviewing a long list of care initiatives — many of which are already complete — the clinician or plan can focus on future needs that are of the highest priority. Using up-to-date information ultimately can reduce alert fatigue and provide a more satisfying and impactful patient experience. In summary, real-time analysis is a noise reducer.

Indeed, the fear of ‘too much information’ often stems from the design of current health information systems, which rely heavily on clinicians and staff to sort through printouts, inboxes, notifications, and data reports to resolve issues in the clinic. Notably, real-time data should not be considered synonymous with an increase in graphs and decisions. Using the driving analogy, data is constantly changing in a turn-by-turn application. However, these applications natively interpret incoming data and only alert the user with upcoming turns or changes to the route. With respect to healthcare, real-time systems also need to be designed to interpret real-time data with actions and prioritizations of the clinician in mind.

The value of real-time data is underestimated. While some inherently accept that real-time clinical information is better than outdated information, real-time data and its immediate interpretation impacts far more than today’s era of business reports. Real-time data and analysis enables feedback interactions and behavioral modifications that cannot be derived from periodic reports.

In the consumer market, real-time responses enable end-to-end services such as ride share, routing, and many financial transactions. In healthcare, real-time clinical information enables better predictive technology and thus an ability to identify trends much earlier. In an increasingly connected world, new clinical services and technologies require instantaneous feedback and timely actions for members and users, enabled by real-time clinical information. If the rapid growth of consumer health devices like wearable monitors is an indicator of upcoming trends, real-time clinical data in population health is just around the corner. Leading healthcare institutions and technology providers need to make sure they don’t miss the turn.

All healthcare providers want the same things: better health for their patients and lower costs. Conceptually, value-based care achieves this shared goal by creating the incentives for all involved to provide better care and secure improved outcomes. Yet this approach lacks the appropriate framework and tools that enable and equip clinicians to achieve value-based outcomes.

Adding to this dilemma is the lack of an appropriate definition of “value” that would enable healthcare organizations to truly comprehend what constitutes “value-based care” and how to implement a successful, sustainable value-based model. True value is realized when efforts are focused on reducing costs and achieving enhanced outcomes rather than simply on attaining quality metrics.

Although the utilization and achievement of these metrics is a step in the right direction to positively impact care quality and outcomes, it’s not enough. Checking off boxes indicating that best-practice protocols are being followed does not necessarily equate to better outcomes or improved financials. Closing this gap between incentives and outcomes requires clinical care to evolve to reflect proactive management of chronic disease and promotion of patient wellness. Incentives alone are not enough; clinicians must also have access to the appropriate tools to achieve those quality goals.

The good news is that value-based payment models are providing the necessary impetus for the creation of radical disruptive practice patterns and new models of care. For instance, uptake of Internet-based care delivery that enable more proactive treatments is on the rise, particularly with chronic illness.

Value-based care is also a significant catalyst of advancements in telehealth solutions. These interventions are effectively disrupting traditional care models by providing the necessary best-practice based infrastructures and tools needed to proactively and effectively address chronic health conditions while seamlessly integrating into provider workflows.

Consider diabetes management. Despite the challenges faced with self-management of their condition, diabetic patients spend an average of just two hours per year with their primary care provider. Further, while physicians strive to provide patients with best-practice knowledge for controlling A1c levels, poor retention of medical information and rapidly changing effects of diabetes put patients at risk for serious health conditions and preventable hospitalizations. Clinical and financial impacts stemming from uncontrolled diabetes greatly influences the steep costs of the condition, averaging $176 billion nationwide each year. Patients and providers must have access to tools that enable enhanced collaboration and ongoing care monitoring to improve outcomes and expenditures for diabetes, as well as other chronic conditions.

Telehealth solutions fill this gap. Features such as smartphone-enabled provider feedback loops can now rapidly deliver easily-understandable, actionable information to patients to facilitate engagement, compliance and sustainable improved outcomes. By empowering patients to effectively self-manage their chronic conditions, long-term care costs to health plans and risk based-entities are significantly reduced, along with the steep costs associated with emergency room visits and hospital admissions.

Additional issues impacting the efficiency and success of value-based care include resistance to change and slow adoption of innovative care models. Industry laggards continue to stunt the progress made by early adopters of value-based care as they consume more resources than are saved. Ultimately, payers and providers must be willing to accept and adhere to new models, which will be helped along by the evolution of technology and processes, such as telehealth, capable of truly impacting care quality, outcomes and expenditures.

When risk is shared and incentives are aligned, value-based care models can enable providers to ultimately reduce expenditures and enhance patient care. If healthcare facilities provide quality care and cost-effective treatments that yield optimal outcomes, both patients and the healthcare system, as a whole, will benefit. Conversely, if there is no alignment, value-based care will collapse under the weight of a reimbursement structure that continues rewarding utilization. For instance, hospitals may continue to benefit from prolonged lengths of stays, while patients are buried under a mountain of medical bills and struggle with uncontrolled chronic diseases.

By delivering proactive, trusted information directly to patients, disruptive technologies fill a critical gap in population health and care management. The key is ensuring that information has been carefully vetted by a physician capable of making necessary adjustments based on the monitoring of a patient’s health in real time along with additional environmental factors such as food intake. This ensures that these interventions enable improved patient care outcomes while strengthening revenues by avoiding penalties and increasing profitability through performance-based bonuses.

Healthcare systems, like any business, are competing for customers (patients) and referrals. In many respects, this competition has increased as patients are either forced to, or opt to, take more control over their own healthcare. The rise of consumerism is pressing healthcare systems to improve their online presence. Physicians and healthcare systems must fully leverage web tools to grow their customer base by empowering patients with the high-quality information they need to make important healthcare decisions.

The Internet has made it much easier for patients to search beyond their local area for the most qualified providers who meet their needs, participate in their insurance plan, and offer the highest-quality services. As a result of this new paradigm, healthcare systems must prioritize the quality and ongoing maintenance of the provider data that feeds their online “Find A Doctor” search and referral tools. Simply put, a poor search experience is a major turn-off. Patients may go elsewhere, referrals (and revenue) are lost, and reputation is damaged.

Patients and referring physicians alike expect to have the same online experience they would with Google and other search engines: instantly and easily find what they are looking for. Healthcare consumers satisfaction grows (and referrals are gained) when they can quickly find a doctor via a simple process that gives them useful information in easily understood terms. Accuracy is assumed.

Patients expect to see provider demographic, practice, insurance, and contact information with a few keystrokes. That’s a given. And when they are presented with more data than expected — such as the provider’s availability, ratings, languages spoken, clinical focus, research interests, treatments provided, and travel directions — even better.

This search process can be further enhanced if the provider’s data includes videos and other multimedia information. Video profiles personalize information and instructional videos can simplify patient visits and improve customer satisfaction and engagement. It’s kind of like online dating and hoping for the perfect match. In both cases, as they say nowadays, a picture can be worth a thousand words, and a video is worth a thousand pictures.

Patients are more likely to book an appointment if their search results direct them to a provider who meets their needs. High-quality data can seal the deal.

Online providers search tools are not just for patients. Physicians use them to identify the most appropriate in-network referral options for their patients. If the information from a referral management website is inaccurate or out of date, it can result in referral leakage, lost revenue, and wasted time. If there’s a delay in the delivery of urgently-needed care, then patient well-being and satisfaction may suffer. This can hurt reimbursement, particularly in today’s value-based care environment. Value-based payments emphasize evidence-based medicine and efficient delivery of care. These basic tenets should be supported by the information from any “Find A Doctor” search tool by ensuring patients see the most appropriate care giver the first time.

None of this, however, can be achieved without a holistic approach spanning the enterprise (clinical, financial, and marketing systems) to capture, manage, and share high quality provider data. A unified approach to provider data management is critical to meet the rising tide of healthcare consumerism and value-base care initiatives, never mind remaining competitive. Providing effective online provider search tools to healthcare consumers and providers is an investment that can quickly pay for itself through referrals that keep patients in network and improve overall satisfaction.

While online provider search tools are certainly not new, they must serve the demands and expectations of increasingly savvy and demanding online healthcare consumers and harried referring physicians trying to balance conflicting demands on their time and attention. Healthcare system leaders should assess how well their organizations online physician referral and outreach programs are meeting these end-user needs and determine relevant ROI measures to improve their effectiveness with an enterprise provider data management approach.

In a June 26 letter, Senators Johnny Isakson (R-GA) and John McCain (R-AZ) urge VA Secretary David Shulkin to lean on the Pentagon for advice as they move forward with their plan to implement Cerner across all healthcare facilities.

A JAMA study investigating the use of electronic pill bottles, combined with social support tools, and a lottery incentive finds no improvement to medication adherence rates among discharged MI patients.

Top News

A cyberattack of an unspecified nature against Nuance takes all of its cloud services – including dictation and transcription – offline. UPDATE: Nuance has since listed those applications that were not affected and the company is providing service updates.

One HIStalk reader reports that the culprit was ransomware. The company’s announcement says the attack originated in Europe.

I reached out to Nuance but my email couldn’t get through because of a Nuance mailserver error that was likely caused by powered-down servers.

Other newly reported ransomware attacks include drug maker Merck and Heritage Valley Health System (PA), which had to take all computers offline. A reader forwarded an email stating that a West Virginia hospital is also under attack.

Early reports suggest that Ukraine-based hackers used a tool developed by the National Security Agency to create the malware, which is also how the WannaCry ransomware was developed. A Ukrainian financial software firm that was infected then apparently inadvertently spread the malware widely via its software update.

Security firms believe the malware is a variant of Petya, which encrypts entire hard drives rather than just the files they contain. Like WannaCry before it, the malware can’t penetrate properly updated Windows computers. Microsoft released a patch MS17-010 in March that closed the exploit used by both WannaCry and Petya.

Preliminary hacker reports suggest that the a “kill switch” has been found that involves creating a file called C:\Windows\perfc. It has also been observed that the hacker message is displayed immediately as the hard drive encryption starts and CHKDSK is invoked, meaning the infected computer can be powered down immediately and left down and intact until the malware can be removed after booting from a Windows OS copy on disk or USB.

Reader Comments

From Meghan Roh: “Re: Epic App Orchard reader comment correction. We offer 50 percent off the first year’s fee, and if any member is dissatisfied in the first six months, we’ll refund the program fee. We have not reduced program benefits. For developers who don’t know what we offer, we provide a list of more than 300 APIs during the enrollment process to help them make their decision.” Meghan is director of public affairs for Epic.

From Established Relationship: “Re: health systems implementing Epic. Epic does not require hospitals to follow its hiring practices (tests, interviews, etc.) They recommend testing applicants, but it’s up to hospitals to say yes or no. If a hospital opts to set aside their usual hiring practice and follow one recommended by a software vendor, they have to accept responsibility for losing experienced resources and implementing a system with a high percentage of inexperienced resources.” I think most health systems follow Epic’s model of maddeningly SAT-like tests and competitive interviews for newly their newly created positions that follow Epic’s recommended job descriptions and titles. I’m mixed on the practice, as follows:

It seems to work in ensuring successful project outcomes, even though it was developed by Epic for hiring new college graduates into their first jobs.

It’s not really too much different from other IT migrations in which those who maintained the legacy system are seen as one-trick ponies who are put out to pasture once their single skill is no longer needed, marginalizing the value of their non-system skills, experience, and relationships.

It would be tough as a health system project executive to announce that you’ve decided to ignore Epic’s advice, whether it involves hiring, project reporting, or anything else. You don’t want to be the person identified as having gone rogue when the project stumbles.

The biggest unsettling fact is that Epic’s model places minimal (actually negative) value on experience with other IT systems, yet its rigid certification and project management requirements nearly always deliver the expected results. That’s threatening to those who equate broad, long experience with better project outcomes.

From Smuggler: “Re: health insurance. Why should the government be allowed to require consumers to buy insurance, or anything else for that matter?” I agree, as long as those invincibles who decide to roll the actuarial dice sign a legally binding waiver acknowledging that they won’t get a penny in benefits from Medicare, Medicaid, or hospitals when something unexpected happens. It’s like homeowner’s insurance, flood insurance, or car insurance – if you opt out of the system, you’re on your own. Whatever’s left of the ACA made insurance available and relatively affordable, so it’s hard to drum up a lot of sympathy for those who could have afforded coverage but chose not pay the taxpayer-subsidized price. All of this would be moot if US healthcare costs weren’t so ridiculously high compared to the rest of the world, the elephant in the room that politicians seem unwilling to address, leaving the only balloon-squeezing choices of covering fewer or healthier people, restricting access to care via ever-narrowing networks or uncovered services, or raising premiums and deductibles.

From KLAS: “Re: reader’s comment about market share. The correct information from the 2016 and 2017 KLAS market share reports is as follows.”

HIStalk Announcements and Requests

We provided an iPad Mini for Ms. N’s elementary school class in New York, which is using the tablet for self-assessing their art projects. She reports, “Students are able to take photos of their work give it a title and describe their art, including what materials they used and how they feel their worked turned out. The Mini allows students a sense of independence. Students are better able to share their work with family by using an art app that gives family an opportunity to comment on the artwork.”

Every year I offer a “Summer Doldrums” deal on newly signed sponsorships and webinars, because otherwise it’s pretty quiet and I get nervous that my industry irrelevancy has escalated. Contact Lorre.

Listening: new from San Antonio-based Nothing More, which plays a slick blend of prog rock, Muse-like soaring orchestration, and hook-laden alternative rock.

Webinars

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET. “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

People

Announcements and Implementations

A new TransUnion Healthcare survey finds that two-thirds of patients with hospital bills of under $500 don’t pay off the full balance, a big jump from 2014 as deductibles increased. The company projects that 95 percent of patients won’t pay their bills in full by 2020, noting also that the percentage of patients who pay nothing at all toward their balances is increasing.

An HFMA/Navigant survey of 125 health system CFOs and revenue cycle management executives finds that 74 percent are increasing their revenue cycle technology budgets, but are struggling to keep up with EHR upgrades and optimization. Consumer-facing tools such online payment portals and cost-estimation tools are common, but few health systems run propensity-to-pay models for individual patients.

St. Joseph Hospital (NH) goes live on the EarlySense continuous monitoring inpatient system that uses an under-mattress sensor to monitor heart rate, respiratory rate, and motion.

In Canada, Waypoint Centre for Mental Health Care goes live on Meditech 6.1.

The State of Connecticut and the Connecticut State Medical Society will launch competing HIEs the next few months, with both organizations hoping users will be willing to pay for their services.

An Advisory Board analysis finds that the average 350-bed hospital fails to capture $22 million in revenue.

Government and Politics

The chairs of the Senate Veterans Affairs and Armed Services committees urge the VA to ask the DoD about lessons learned in its EHR procurement and implementation, expressing concern about potential VA cost overruns, implementation delays, lack of standardized processes, and excessive customization.

A GAO report says the VA’s clinical productivity metrics provide incomplete and possibly misleading information, noting that those metrics fail to capture information from contract physicians and advanced practice providers; don’t adequately incorporate clinical workload intensity; and are hampered by providers who don’t log their time and activities consistently. The lack of good data prevents the VA from identifying and promoting best practices, GAO concludes.

Other

A hospital scrub nurse in Australia develops Scrubit, which improves OR setup by automating preference cards, setups, and lists of required equipment.

British military doctors blame the Ministry of Defence’s IT system for their mis-prescribing of antimalarial drugs for soldiers being shipped out to Afghanistan. They say the system is slow and can’t always bring up patient histories, meaning soldiers may be inappropriately prescribed mefloquine, which can cause depression and suicidal thoughts. The decade-old DMICP system is a customized version of EMIS PCS, provided by Canada-based vendor CGI, which has been the key player in quite a few IT screw-ups including Healthcare.gov.

MIT Technology Review says IBM is overhyping Watson, but the product still has the best chance among AI competitors of delivering healthcare value assuming that IBM can gain access to the data the system requires. The article says IBM has a leg up on startups because conservative large health systems trust it more than any other company. It notes that both IBM and MD Anderson raised expectations unreasonably before the organizations recently shuttered their joint $39 million project (budgeted for only $2.4 million). A snip:

To train Watson to go through giant pools of data and pull out the few pieces of information important to a single patient, someone has to do it by hand first, for thousands and thousands of cases. To recognize genes linked to disease, Watson needs thousands of records of patients who have specific diseases and whose DNA has been analyzed. But those gene-and-patient-record combinations can be hard to come by. In many cases, the data simply doesn’t exist in the right format—or in any form at all. Or the data may be scattered throughout dozens of different systems, and difficult to work with … To really help doctors get better outcomes for patients, however, Watson will need to find correlations between what it reads in health records and what Tang calls “all the social determinants of health.” Those factors include whether patients are drug-free, avoiding the wrong foods, breathing clean air, and on and on. But Tang concedes that today almost no hospitals or medical practices get that data reliably for a significant percentage of patients. Part of the problem is that hospitals have been slow to take up modern, data-driven practices. “Health care has been an embarrassingly late adopter of technology,” says Manish Kohli, a physician and health-care informatics expert with the Cleveland Clinic.

Researchers find that less than 1 percent of pathology specimens provide incorrect results due to mishandling (either switching samples between patients or “floater” cross-contamination), but DNA fingerprinting can eliminate those problems, albeit at a cost of $300 per test. Private insurance generally pays the cost to avoid higher bills for unnecessary or delayed treatment, but Medicare doesn’t. One urology practice starting using the error prevention system after being threatened by a lawsuit after it removed a man’s cancer-free prostate based on another patient’s specimen.

A study finds that a combination of wireless smart pill bottles, lottery-based incentives, and social support did not improve medication adherence or readmissions for post-MI patients.

A drug company whose opiate addiction treatment drug was getting little market traction hires lobbyists and makes political contributions to influence drug court judges, who then order offenders to be treated with the product that is injected monthly. The resulting sales have increased the company’s market cap to $9 billion. On the positive side, the drug seems to work well in blocking the pleasurable effect of opiates, it’s not addicting, and it’s long lasting. The negatives are lack of proof of long-term efficacy and its $1,000 per month cost.

Sponsor Updates

The local paper recognizes AssessURhealth Director of Operations and veteran Kyle Mynatt for his community contributions.

The CBO estimates that the Senate bill to repeal the ACA will increase the number of uninsured Americans by 22 million by 2026, a small improvement over the House version of the bill, which was estimate to increase the number of people without insurance by 23 million.

A doctor in Oklahoma is being charged with five counts of second-degree murder after prescribing a combination of opioid painkillers, Xanax, and muscle relaxers that directly contributed to five overdoses.

Former VP Joe Biden announces that he is launching the Biden Cancer Initiative, a venture that focus on developing and driving implementation of solutions to improve cancer detection, diagnosis, and treatment.

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

Emotions and Motions

High off my first Duathlon World Championships (2014) as a member of TeamUSA, I posted “Data Driven Performance.” I shared how my athletic performance transformed as I applied healthcare lessons learned around big data and business intelligence.

Over the ensuing two years, I continued to refine and improve based on applied analytics until that fateful Manhattan morning last fall. Running around Battery Park, training for my first sub-90-minute half-marathon, I felt pain radiate in my left knee. Torn meniscus!

I was devastated. Being extremely physically active since my youth, I felt significant loss. Competing since I left the womb, I was no longer in the game. Incapable of walking without a crutch, I stumbled for blocks around the Hospital for Special Surgery where I completed my pre-surgical consult. While I was fortunate to have surgery under the knife of one of the world’s best orthopedic docs, I was going to have to start completely over. I dutifully checked into Professional Physical Therapy and pushed my handlers to the edge with my constant begging to let me run and help me get faster than before.

I decided to focus on 2017 as my recovery year and to come back strong in 2018. I set some motivational goals related to run-speed, so I was leveraging data a little, but not to the level of the past. I was hitting my time targets for 5K, 10K, and half-marathons. I was logging tons of hours on the bike, but not concerned with wattage or RPMs. I was throwing in some extra weights and cross training while focusing a little on core.

I wasn’t entering my data points, but just making sure I was hitting the gym with a good cadence. I stopped measuring precise portions and calories and mixes and potions. I ate when hungry and drank when thirsty. I know my first coach Amari was frowning, but I was putting all the other principles she taught me to work. Yep, I gained a little weight, but everything sure tasted good!

I began to enjoy the journey, have more fun and not take all the data too seriously. I began to listen more to my body than to the data points and daily outcome measurements. I started to look forward to my long runs along the Hudson and my four-hour extended indoor simulated cycling drills inside of EJ’s Euless garage. Waking up at four o’dark thirty was no longer a chore. In fact, the alarm merely became a backup to my natural cycle to wake early and enjoy the journey.

Almost as a dare from my therapist, I decided to prematurely enter the 2017 TeamUSA National Duathlon (Long Course) Championships in Cary, North Carolina. Just seven months post-op, I took the dive without requisite coaching and data-capturing electronic gizmos. I reasoned that I had little chance to make the team, so I should just race for the love of it. Not to make the team, but just to enjoy the fact that I could train enough to compete so soon after surgery.

I loved every minute. The bonus was that I had enough in me to make the team, qualifying to represent our country at the 2018 World Long-Course Duathlon Championships in Switzerland. Nothing like the Alps to test one’s stamina and spirit!

Emboldened by the Long-Course Duathlon results, I figured that I might as well take the same approach for the TeamUSA National Duathlon Championships in Bend, Oregon a few days ago. In addition to competing in the Standard-Course Duathlon Championship, I decided to compete the following day in the Sprint-Course Duathlon Championship. Again, I shrugged off the use of my arsenal of data-collecting devices for my body and bike and instead focused on enjoying the moment. I was free to just listen to my body and take in the scenery.

My performance was raw and painful, but I ended up securing the last available spots on both teams. In addition, one of my long-time teammates and I became the first athletes to make all three of the TeamUSA Duathlon squads in the same year. No data — just fun and gut.

In the final days of training, I thought about my minimalistic data approach and reliance on fun and gut and how that intersects with the workplace. Will we go so far out towards business intelligence, precision medicine, artificial intelligence, and machine learning that we lose emotion? Might we stop listening to our gut and miss an important determinant? Will we listen to feelings or lose empathy? Go through the motions at the cost of emotion? Lose a piece of ourselves and the value of human touch in the healing process?

I don’t know. Oh, but what I do know! What I do know is the joy I experienced crossing that finish line, giving all my heart and muscle. Oh, I will never forget the tears I shed embracing my wife when I learned I secured the last and final spot on those national teams! The floodgates opened! Oh, what I also know is the feeling I will have with “Marx” emblazoned below “USA” on my star-spangled uniform at the Standard and Sprint Duathlon World Championships starting gates in Denmark.

Would I feel the same high if my accomplishments were due to my obsession with data analytics and my nightly uploads and downloads of each day’s data? I don’t think so.

In the end, life requires that we make room for both the motion and the emotion. They aren’t mutually exclusive. What matters is striking the right balance between science and art. When I hit the 2018 World Championships representing our country’s colors, I will certainly be data-driven again, but I will also make plenty of room for the heart and the gut. At the end of the day, it is my soul that crosses the finish line, not a machine, and I will always remain emotional.

In our work, we must do the same. Balance the motion and emotion. Enjoy and embrace the intersection of art and science without being blinded solely by science and motion. Never, ever forget the emotion, for that is what makes us human.

A reader recently reached out with some thoughts on life after a large go-live:

Our large academic medical center went live with ambulatory EHR several years ago. The clinicians and residents were used to many of the system features already from inpatient, but we still had a lot of configuration decisions, setup, training, reduced volumes, then a fair amount of post-live elbow-to-elbow support in decreasing amounts. Though there were a few frantic phone calls with crying and screaming clinicians or administrative staff at the time, it went fairly well all things considered.

However, many post-live optimizations were never completed and it was assumed that new hires could just be trained by existing staff. There is minimal formal training and no discussion of the individual configuration options that we helped people set up during rigorous pre-live training. We lack discussion of workflows and regulatory requirements that have shifted or are no longer tracked, and other changes have been made to the system that have broken prior customizations. Documentation of our individual decisions was by vendor consultants and I don’t think any coherent documentation was left behind at the end of the engagement. We aren’t even alerted to processes that have obviously become broken because the front-line clinicians and staff don’t know any different, assuming that it’s just the poorly designed software at fault. And the further we are from go-live, the worse it gets. It’s like throwing the frog in boiling water or turning the heat up gradually.

Do other systems or consultants do a better job of managing this as they find themselves several years post go-live?

At least in my experience, many organizations struggle with this. However, I see it more acutely in organizations that treated their EHR projects like IT projects instead of operational or clinical projects. The go-live itself is often seen as the endpoint, with little vision around the ongoing efforts needed to maintain a system and its users at a top tier level of performance. There is a lot of money spent to support the go-live, so groups tend to economize on ongoing support.

It sounds like your approach leading up to the migration was fairly tried and true, making the most of existing knowledge from the inpatient system while tending to the decisions that needed to be made specific to the ambulatory system. You had a good amount of elbow support, which many clinicians appreciate. Beyond that, many groups find a greater level of success spending more resources upfront to encourage (and/or force) providers to complete a set number of test patient scenarios prior to the go-live, which potentially makes for an easier go-live with less reductions to the schedule or less elbow-to-elbow support.

I personally like requiring physicians and their care teams to document a good number of patients with their most common chief complaints, along with documenting sample visits on some of their most complicated patients. That tends to prepare them a bit better and they have better mastery than if they try to learn during go-live. I’ve found the stress of the go-live itself tends to make learning difficult.

As you mentioned, post-live optimization is where things often fall apart. Some organizations don’t even budget a post-live optimization program into their implementation, which is a grave mistake. Budget permitting, I like to perform circle-back visits at two weeks, 30 days, 60 days, and 90 days after go-live. This allows the support or implementation team to see what processes are working well in the office and what processes have become ripe for bad habits. Even with the most rigorous training and practice, it’s hard to retain all the nuances of different EHR workflows, especially for patient care situations that you don’t see every day.

For those groups that did budget a post-live optimization program, I frequently see those resources shifted to other initiatives that have taken priority for one reason or another. Maybe the group shifted into acquisition mode, maybe they joined an ACO, but optimizing the EHR and practice operations seems to frequently fall by the wayside.

You mention shifting regulatory workflows and that is an issue I see frequently, especially with practices that participate in multiple grant programs. Once I worked with a group that was insistent that they needed to document the date of the last dental exam on all patients. I continued to ask “why” to every reason they gave until we distilled down to the fact that it was originally mandated for a grant in which they hadn’t participated in more than three years. They had been on the brink of customizing a template to capture that date, not knowing that it wasn’t important except for a sub-group of patients for whom that information was already captured in the system’s health promotion templates.

Institutional memory can be a blessing and a curse in situations like this, the latter when people remember things being one way but not the underlying reason and are so dedicated to keeping things the same that they lose sight of what they are doing. It can be a blessing when you have a stable workforce that can do things like train new workers, but that is certainly the exception in many ambulatory workplaces today.

The idea that workers will just train the new people as part of their ongoing daily duties doesn’t tend to produce desired outcomes. In practices where I’ve worked, on-the-job training has been a bust as trainers don’t have time to focus and trainees don’t understand what is best practice and what is their trainer just making it through the day. Fortunately, in my current practice situation, our version of on the job training actually has a rigorous schedule behind it with checklists and skill proficiency. The trainer and trainee are added to the office schedule on top of the normal staff, so that the training process can be focused. It costs more up front to take this approach, but it’s been more than worth it.

Training of new employees has to include training for user-level preferences and configurations because these are the things that make EHR workflows efficient and personal. When I perform EHR optimizations (or EHR clean-up missions, as the case may be), these are the first elements I emphasize. They’re often the proverbial low-hanging fruit that gets users into a more receptive state of mind for when you come back to cover more challenging workflows.

I cringed when I read the comment about the documentation of decisions being done by consultants who didn’t leave coherent documentation. That’s one of the things that pushes me over the edge. Documentation and hand-off should be part of every engagement, to ensure that your client hasn’t simply been handed a fish, but rather taught to tie his own flies, cast the line, reel it in, fillet it, and cook it over a fire that they have built.

In my consulting engagements, the decisions are documented not only in a spreadsheet-style matrix, but in a corresponding executive summary slide deck. It’s not enough to know that a customization was made, but you need to know why so that you can determine whether it needs to be maintained. Customizations should be reviewed with every major upgrade and evaluated to see if they need to be retained or if they can be retired in favor of new functionality. It’s also a great opportunity to make sure the physicians for whom they were built still work in the organization. Otherwise, as a general rule, the customizations can be put to rest as long as no one else has adopted them.

In those situations, I like to use database queries to determine if the customizations are even used. I once worked with a physician who was ready to fight tooth and nail to keep a customization until I showed her the queries that proved that out of every 100 times she used the template in question, she only used the “have-to-have-it” checkbox one time. In that situation, free-texting would not have killed her.

The comment that users assume the software is at fault rather than looking at the process also resonated. I’ve found that the organizations that handle long-term sustainable process improvements the best do so because they have dedicated teams that continue to work with practices to make sure changes are adopted and incorporated in an ongoing fashion. They make sure users have ready access to training in a variety of formats, whether written, recorded, live, or 1:1. They recognize that users have different learning styles and often crazy schedules and may need accommodation to become truly proficient with an application. And they’re willing to challenge whether it’s a problem with the user, the training, the content, or the technology. They’re not afraid to ruffle feathers getting to a root cause or trying to do the right thing for patient care and user satisfaction.

I work daily with clients who aren’t aware that their vendors have documentation around not only best-practice EHR workflows, but best practices for running the office in general. Several vendors have in-house consultants who are available to help clients with these issues, although I’ve seen come clients give them the cold shoulder because the feel the vendor-employed consultants are inherently biased. I’ve seen them argue with vendor educators who are trying to emphasize well-documented and published clinical best practices, belittling them and dismissing their wisdom just because their paycheck comes from a vendor.

The best example I’ve seen is a group that argued with the vendor about hanging signs to encourage diabetic patients to remove their shoes and socks for a foot exam. They told the vendor it was outside the vendor’s scope, despite the vendor rep being a registered nurse and having citations from articles proving the approach as effective in improving foot exam performance metrics.

The bottom line is that some groups do handle the ongoing maintenance of a system better than others. Those that have a plan accompanied by leadership buy-in and a corresponding budget do best. Others that don’t meet those criteria often become easy prey for vendors trying to sell replacement systems. It’s amazing to me when a client won’t sign a $50,000 proposal for optimization, but ends up paying millions for a new system when their previous system would have been just fine had they maintained it. It’s like never changing the oil in your car and then being surprised when the engine seizes.

How does your organization handle post-live support and optimization? Email me.

In light of the increase in medical records inadvertently becoming exposed to the Internet, Google adds medical record information to its list of information users can request be removed from its search results.

Top News

Google adds medical records to the handful of categories that users can ask the company to remove from searches. Someone whose medical records have been exposed inadvertently or otherwise can ask Google to hide their information from its search results.

The material is still visible on whatever site posted it, but is less likely to be discovered when it’s filtered from Google searches.

Reader Comments

From Vendor Locking, Data Blocking: “Re: Cerner and the DoD/VA. You covered this a year ago and it’s even more outrageous in light of the VA’s decision. Cerner forced the DoD to host MHS Genesis because, by Cerner’s rules, only Cerner can, even though the DoD finds that it’s technically doable by others. Cerner ‘is not willing to negotiate at this time for the procurement of the data rights that would enable the government to utilize the Cerner solution in a competitive environment.’ Why? Because it ‘could adversely impact Cerner’s … competitive market advantage.’ Is this is the good faith Shulkin should expect heading into negotiations without a competitive bid?” I don’t know much about government procurement (and don’t want to), but publicly naming Cerner and presumably Leidos as the VA’s no-bid vendor for a contract whose value could exceed $10 billion seems absurd regardless of the Congressional pressure the VA is facing. The DoD messed up in failing to force Cerner (pre-contract, of course) to open up the DoD’s hosting options even though Cerner came up with a hollow-ringing excuse about population health management requirements, forcing us taxpayers to ante up a few more dozen million dollars that unfortunately constitute little more than a rounding error in the massive project.

From Supine Position: “Re: losing an IT job when systems are replaced. It’s SOP for health systems implementing Epic.” Indeed it is. Epic forces its own employment model onto its customers, requiring experienced hospital IT employees to interview competitively for newly created Epic positions and to take Epic’s bizarre but apparently effective logical reasoning and IQ-type tests that are scored secretly by Epic, resulting in only a gladiator-like thumbs up or down passed along from Epic to the hospital’s project executives who defer to Epic’s wisdom for fear of rocking the boat of their employer’s gazillion-dollar project. It’s almost like Epic is invalidating the hospital’s own methods of choosing and keeping employees. The rank and file who get passed over for the Epic team are thanklessly turfed off keep the legacy system lights on, huddling depressed like death row inmates as they watch former teammates head off to new physical locations, Epic training, and a secure employment future. I’m surprised that hospitals are readily willing to part ways with employees who have decades of experience, but on the other hand, the Epic model of creating new jobs and then eliminating the old ones is a convenient way to clean house without feeling guilty. Make no mistake – when your health system employer chooses Epic but not you, your IT life, your social standing among peers, and perhaps your city of residence will change.

From Interested: “Re: Quantros. The CEO is leaving, according to this announcement that identifies her new position.” A May 26 trading update from Informa PLC says that Quantros CEO Annie Callanan will join the business intelligence and publishing company this summer. She joined Quantros in July 2014.

HIStalk Announcements and Requests

The majority of HIStalk readers don’t believe Apple will live up to the hype in making the iPhone a significant interoperability component. John Smith says Apple doesn’t understand interoperability but instead is mostly interested in selling hardware to customers of its walled garden. Nick predicts Apple will be Fitness Trackers Round Two in giving already healthy people yet another gadget to play with. JC says the company’s deep pockets and strong consumer focus could allow it to make a difference, while Mobile Man says people need ways to store and share the medical information of themselves and family members that could be accessed by providers and anything Apple can do to support that would be great.

New poll to your right or here: Have you ever lost a job due to a health IT implementation?

Jenn did a great job covering for me while I was on vacation for several days. I like that she makes me at least temporarily redundant so I can get away without worrying about HIStalk, although I’m always anxious to get back in the saddle.

My candidate to become the next MySpace – LinkedIn, which under Microsoft’s ownership has become maddeningly slow, is being bloated with questionably useful and unintuitive features, and is becoming a nagware showcase of trying to get users to buy premium services. I actually dread looking someone up on LinkedIn now, nearly as much as I hate getting unsolicited pitches from it (like never-ending recruiter spam and generic partner pitches from India-based companies).

Webinars

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET. “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

ONC’s Director of Meaningful Use, Joshua Seidman, PhD resigns to take a job as managing director of quality and performance improvement with Evolent.

The Supreme Court rules to uphold the ACA, including the individual mandate.

A GAO report finds that the VA and DoD have made progress in their pilot project to integrate care at the James A. Lovell Federal Health Care Center (IL), but delays in implementing the IT component have created additional costs.

Practice Fusion gets $34 million in Series C funding from by Artis Venture.

Five senators introduce a bill that would create a national standard for notifying affected individuals about information security breaches.

Ten years ago:

Michael W. Carelton joins HHS as CIO.

The Healthcare Solutions business of JPMorgan Chase and RelayHealth offer an integrated set of claim and payment processing solutions.

Mediware delists itself from the NYSE Arca stock exchange.

Two DoD medical agencies attempt to stifle use of the Joint Patient Tracking Application so they can spend millions to build their own.

Cerner gets 510(k) clearance for its new transfusion and specimen collection system that will be marketed under the Cerner Bridge Medical name.

Weekly Anonymous Reader Question

Last week’s survey: what is the best practice you’ve seen for a company to encourage gender equity?

Pay equality.

Promote the qualified women into management, upper management, and into the C-suite.

I have not seen this implemented anywhere, but names should be removed from resumes. Resumes should stand alone on the quality of the content, not the name of the applicant. This would also level the playing field for people who get bypassed (and there are a LOT who do) for their “ethnic” sounding name.

Can we please stop referring to our MAs, RNs, and receptionists as “girls,” as in “I’ll have one of my girls get that for you” or “My girls didn’t come in today, so we unable to see patients.”

Actually promote women to senior line roles. Most senior teams are a horde of white guys and a few token women in legal, HR, and marketing.

Data, data, data. Benchmark all positions against market rates and target hiring/paying everyone at the 50th percentile. Stop asking new hires what they make (now the law in Massachusetts); decide what the position is worth and pay that to all applicants.

Having a respected female leader.

Hire more men? Not always true at upper management, but at middle and down, my teams have been dominated by women for as far back as I can remember. Nurses (female-predominant career) switching to IT plays a huge role in this.

None that I’ve seen, but the term gender equity is a good example of an oxymoron.

Truly following an employee engagement strategy like those from Gallup, Press Ganey, etc.

It’s not really a best practice per se, but I started my career at Epic, and as a female, I did not see any limits to my career based on gender. The CEO and many senior leaders are female. I think having that as a first example helped shape what I will accept and what I have sought out culturally at future employers.

Several years ago while I was on active duty, the Air Force opened fields that were previously closed to women. Of all the careers positions that I have held since then, I have come to appreciate that no organization does a better job at “assimilation” than the military.

FDA Commissioner Scott Gottlieb, MD outlines his digital health plans for the agency, which include the development and launch of a third-party certification program for low-risk digital health products.

Announcements and Implementations

The ACOs and IPA of Orange Care Group will implement Epic’s Healthy Planet population health management system and will also offer its EHR via Memorial Healthcare System (FL) and Epic Connect.

Government and Politics

Some of the scariest words I’ve heard out of Washington, DC involve the idea that people shouldn’t be forced to buy health insurance they “don’t want or need.” Who might that be, other than psychics who can predict with certainty that they won’t have an auto accident, experience a stroke or heart attack, get hit by an exploding genetic time bomb, or find that they have cancer? Choosing not to buy insurance is a gamble in which those who bet wrong on the likelihood of circumstances beyond their control stick hospitals with their bills (and thus everybody else who was responsible enough to insure themselves), receive inadequate care, or lead their families into medical bankruptcy. There’s a reason that even good drivers are forced to buy auto insurance even though they might rather spend the money elsewhere. Healthcare is so expensive that even the relatively rich couldn’t afford the uninsured cost of a major, short-term illness or any long-term one. Personal responsibility in healthcare comes from both lifestyle decisions as well as backstopping the inevitable eventual costs with insurance.

Meanwhile, here’s the most insightful comment I’ve seen on the US healthcare system given that everybody focuses on the cost of insurance that inevitably reflects the cost of healthcare services.

Sales

Australia’s Northern Territory selects InterSystems for its $196 million clinical systems replacement project. Telstra Health, Epic, and Allscripts failed to make the cut from the shortlist, while Cerner, Meditech, and Orion Health didn’t advance to the final four.

Decisions

Ocean Beach Hospital (WA) will replace Healthland (CPSI) with Epic in October 2017.

University of California Irvine Medical Center (CA) will go live on Epic in November 2017.

Winneshiek Medical Center (IA) will replace Meditech with Epic in September 2017.

Mayo Clinic Hospital – Rochester (MN) will go live on Epic in 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

Privacy and Security

Anthem will pay $115 million to settle a class action lawsuit over the 2015 cyberattack that exposed the information of 78 million people.

Other

A hospital in India denies well-placed rumors that its patient oxygen supply went offline for 15 minutes and thus killed 11 patients, even though reporters seeking information found that the records of the victims had vanished along with the oxygen supply logbook. Administrators of the 1,400-bed hospital say there’s no need for alarm since 10-20 patients die there each day. The same hospital killed two children last year after giving them nitrogen instead of oxygen.

A professor in South Korea says hospitals interested in artificial intelligence should focus their efforts on EHRs instead of IBM Watson. He adds, “I have to question whether we can use Watsons with absolute trust. It seems that hospitals have introduced the technology mainly for publicity reasons. They are promoting Watson to win the competition, especially now that its cost is falling.”

A depressing New York Times article covers the opioid addiction problems of Delray Beach, FL, whose paramedics responded to 748 overdose calls in 2016, 65 of them involving fatalities. Most of the victims were from elsewhere since the town has several addiction treatment centers that draw in addicts from all over the country who stick around afterward, who are then pursued by minimally supervised, often fraudulent, and insurance-paid treatment centers, labs, and group homes that profit from their relapses. Delray’s mayor notes that you can’t cut hair in Florida without a license, but you can run a substance abuse center. Also noted is that the Affordable Care Act gave young addicts insurance that made them a target for unscrupulous operators found in abundance in South Florida, to the point that they try to steal business from each other by offering addicts manicures, gym memberships, and sometimes even drugs, also rooting for their relapses that restart the insurance benefits clock. Residents complain that the rapidly proliferating sober homes create endless noise, property crime, and homelessness once a resident’s insurance runs out.

Georgia Tech researchers are developing a touchscreen that will allow dogs to call 911 if their owners experience distress or ask them to summon help. Those in technology-powered homes who plan in advance might name their dogs Alexa or Siri to double their chances of obtaining assistance.

Weird News Andy notes the potential rollout of “self-driving doctors,” in which a Seattle design firm proposes a rather ridiculous system of in-home monitoring and a self-driving health pods that people step into to have their health-related measurements taken at their own location. The pods would also offer telemedicine sessions and dispense medications via artificial intelligence, whatever what means. The company says it’s just a concept, but adds that “there’s a very big need for much better care experiences.” I wish the many people who propose Jetsons-like ideas for improving health would take the time to understand it first, particularly from a public health perspective, but unfortunately all the techno-gimmickry focuses on that small population of self-paying people who can theoretically fuel a company’s bottom line.

Top News

Senate Republicans release a draft of the Better Care Reconciliation Act of 2017. Main points of discussion thus far seem to be the bill’s curtailment of Medicaid expansion, elimination of most of the taxes created to pay for coverage expansion, elimination of subsidies for out-of-pocket costs beginning in 2020, restrictions on tax subsidies, and giving payers the right to charge older consumers more than younger ones. It does away with individual and employer mandates, and keeps policies related to pre-existing conditions and dependent coverage. A vote on the final bill is expected next week.

Webinars

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET. “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

Acquisitions, Funding, Business, and Stock

Theranos reaches a tentative settlement with Walgreens that would result in the retail pharmacy getting only $30 million and losing more than $100 million of its original investment. Theranos recently told investors that it only has $54 million left, while its monthly expenditures are said to be around $10 million.

Bucking the current market-exit trend, Oscar Health will expand its ACA health plan offerings in Ohio, Texas, New Jersey, Tennessee, California, and New York. “For all of the political noise, there are simply too many lives at stake for representatives in Washington, DC not to do what’s right for the people,” says CEO Mario Schlosser, who co-founded the company in 2013 with Josh Kushner, the brother of President Trump’s son-in-law Jared.

Chronic disease management startup Omada Health lays off 20 employees just over a week after announcing a $50 million investment round led by Cigna.

Forward Health Group is awarded a patent for its “system and method for the visualization of medical data,” which the population health analytics vendor will use to enhance its PopulationManager and PopulationCompass products.

Announcements and Implementations

Epic will offer end users the ability to license Mediware’s blood bank management system in combination with its Beaker LIS.

University of Pennsylvania Health System goes live on NLP technology from Linguamatics.

Sales

The City of Corpus Christi Fire Department in Texas selects RCM software and ambulance supplemental payment program consulting services from Intermedix.

In England, Taunton and Somerset NHS Foundation Trust will implement DeepMind Health’s Streams patient safety alerts app over the next five years. DeepMind Health is a London-based Google company that encountered media scrutiny in the UK last year after patients cried foul at having their data involved in a Streams pilot without their consent.

Carolinas HealthCare System (NC) will deploy Cerner’s HealtheIntent population health management technology across the organization, including its Carolinas Physician Alliance. The health system – a Cerner Millenium shop – will also extend its remote hosting agreement with the company.

Privacy and Security

The Halifax Supreme Court in Canada rules that Roseway Hospital must pay $1 million to members of a class-action lawsuit filed over a 2012 privacy breach. It seems to be the first successful suit of its kind in Canada.

Innovation and Research

An Accenture report projects a annual growth rate of 40 percent through 2021 for AI focused startups working in healthcare, with robot-assisted surgery, virtual nursing assistants, and administrative workflow assistance topping the list of top AI applications in healthcare.

A CHIME survey on medication reconciliation practices conducted on behalf of DrFirst shows that 75 percent of hospital executives are most concerned about inaccurate or incomplete medication data, followed by inconsistencies across departments and shifts, and discharged patients being given incorrect medication lists.

Government and Politics

In India, the state of Andhra Pradesh’s Department of Health, Medical, and Family Welfare signs a three-year agreement with Cerner for HIE services, data analysis, and policy expertise. The organizations will set up a Knowledge Command Centre from which to direct operations. Chief Minister N. Naidu has expressed a desire to eventually give every citizen access to their health data electronically.

Other

A man who jumped from an ambulance in a drunken state sues the City of Staten Island, its fire department, and the EMS workers who attempted to care for him. He claims they should have prevented him from taking the leap, and ultimately caused the injuries he sustained as a result. The patient’s lawyer contends that, though the facts of the case are unusual, he was in such an inebriated state that he was in no condition to make decisions about his own safety.

Contacts

The HUMAN Project calls for New Yorkers to “help power the scientific research and societal solutions of the future.” The initiative is looking for 10,000 participants who are willing to share virtual reams of personal information, including cellphone locations, credit card habits, and blood samples over the next 20 years. Researchers plan to use the data for insights into health, aging, education, and more. Baseline data for accepted participants includes everything from basic laboratory panels to IQ and genetic testing with repeat labs every three years. Participants are eligible for a payment of $500 per family.

The mention of the word “family” made me wonder if they’re going to include children for all of the projects. Although minors are included in research studies, it’s usually for a defined goal rather than for a large set of projects. What happens when minors reach majority and no longer want their data shared? Can they opt out? The website mentions the need for research beta testers and will accept participants age 13 and older.

The project has paid a lot of attention to data safeguards including encryption and firewalls, but as we all know, nothing is non-hackable. They claim outside researchers won’t have access to raw data, but we’ve seen past efforts to re-identify anonymized data sets that have worked. The effort is being coordinated by New York University, and I would love to be a fly on the wall for institutional review board discussions. It looks from the website like they handle the consent process for their beta testing through an online consent portal that allows potential participants to watch videos about consent, which it says are “quicker and easier” than reading the full text of the informed consent document. Personally, I’d want to read every word, but that’s out of the question since I don’t live in New York City and that’s one of the primary screening criteria.

On the other hand, the National Institutes of Health is looking for 10,000 beta testing participants for its “All of Us” precision medicine research program. The beta program is the precursor to a plan to power their research with a cohort of 1 million patients as they look at genomic, clinical, and lifestyle data. The beta program will be coordinated by the University of Pittsburgh Medical Center, which plans outreach at more than 100 locations during the next five months. Ultimately, NIH plans for the program to last for 10 years, and it doesn’t appear to have any geographic restrictions.

Compared to the HUMAN Project, All of Us looks a bit more like a traditional research platform, open to adults in the US who are able to consent on their own and who are not in prison. Participants have to be over 18, although they may allow minors in the future. Also in contrast to the HUMAN project, participants aren’t required to have smartphones to participate. That’s likely to give it a broader cross section, although they’re narrowing it down to English and Spanish speakers currently with a plan to expand to more languages in the future. I don’t have an invitation code so I couldn’t get very far with the website. It’s a little less sexy than the HUMAN project but feels more accessible.

Given the nationwide nature of their 100 beta sites, and the fact that I’m a patient at one of their partner hospitals, maybe I’ll get an invitation. Participating would certainly be an experience. They hope to launch the major part of the national project in late 2017 or early 2018 – once testing is complete. I appreciate a vendor that says their go-live dates are fluid based on the results of testing, because you don’t always get that candor from EHR vendors. Not to mention, the technology isn’t the only thing being tested – it’s the systems, processes, and engagement approaches as well as their ability to build rapport with diverse groups of people in many regions.

All of Us has similar language on its website about data security and safeguards. Given the fact that NIH is sponsoring the initiative, I think it’s safe to say that they understand the implications of a breach or hacking. Thinking back to the HUMAN project and its app, though, it seems that most people don’t give a lot of care to how or with whom they are sharing their data on their phones. Among people I’ve informally polled, most accept all requests for application permissions (and therefore data sharing) because they don’t have the time or interest in determining whether they can use the app they want without allowing permissions. Indeed, we live in interesting times.

I mentioned last week that my EHR platform was experiencing some API issues, and I was annoyed by the fact that they kept sending us emails about the outage that offered no information. A reader responded, mentioning similar struggles and asked what changes would make the communication more meaningful. First, I’d like more information on what stage of investigation the issue might be in. Are they still gathering data? Are they running traces? Are they to the point of troubleshooting? Have they even identified the problem yet? Once the problem has been identified, I’d like to hear about potential timeline to resolution, whether they’re testing a fix, etc.

I’m sure a lot of customers don’t want that level of detail, although it is nice to know whether they’ve even found the problem and are fixing it or whether they’re still digging. I’d also like a published timeline for communication, like we had when I was a CMIO. If it was a critical outage, we provided an update every hour. Major but non-critical outages led to updates every other hour. And minor issues were updated mid-day and at close of business. Finally, I would want notification that the issue was resolved. In the case of the API issues we were having, there was never a notification that they were fixed. We stayed in the application with some workarounds rather than going to downtime procedures, but had we been on paper I definitely would have preferred a notification rather than having to keep checking to see whether things had been sorted. Since the problems were mostly with pharmacy search and e-prescribing, they were difficult to replicate using test patients.

An Accenture report projects a annual growth rate of 40 percent through 2021 for AI focused startups working in healthcare, with robot-assisted surgery, virtual nursing assistants, and administrative workflow assistance topping the list of top AI applications in healthcare.

Theranos reaches a tentative settlement with Walgreens that would result in the retail pharmacy getting only $30 million and losing more than $100 million of its original investment. Theranos recently told investors that it only has $54 million left, while its monthly expenditures are said to be around $10 million.

During President Trump’s meeting with technology executives last week, industry leaders pressed him to shut down some of the governments 6,000 data centers and move the data storage work to private industry, while simultaneously lobbying for more data transparency, calling for a “data liberation administration.”

CMS publishes the 2018 Quality Payment Program proposed rule which allows for the continued use of 2014 Certified EHR technology, and increases the participation threshold from $30,000 to $90,000 in Medicare Part B charges, which is expected to excuse another 130,000 practices from participation.

Two West surveys on healthcare and patient satisfaction finds that patients spend a lot of time researching providers before choosing one, but are quick to move on if they are not satisfied with the care they receive.

Top News

Teladoc will acquire Best Doctors, a global company that provides virtual medical consult services to employers and payers, for $375 million in cash and $65 million in common stock.

Reader Comments

From Ex-Epic: “Re: Epic billing services. Not sure if this has already been announced publicly. It looks like Epic is starting a Billing Services team: ‘Epic is seeking bright, motivated individuals to join our new Billing Services team as we enter the world of medical billing. Our goal is to simplify the payment process by helping Epic organizations with the complexities of submitting claims and posting payments. Attention to detail is vital as you’ll be posting payments and denials; reconciling payment files, claims, and statements; resolving posting errors; and calling payors to follow up on outstanding or unpaid claims.’”

From Ex-McK: “Re: McKesson’s ranking. The Fortune 500 issue was not too kind to the Pharma division of McK and it’s difficult to fathom how John Hammergren can bring in an average of $60M+ per year over the last 10 years. As one of those who was ‘released’ from my employment I find it galling, but that’s probably just me.” Fortune’s annual list puts McKesson at number five, just ahead of UnitedHealth and CVS Health. I didn’t care to dig any deeper into the list given its obnoxious interface and floating auto-play ads that took too long to recognize my many attempts to stop them.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET. “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

People

After just one year on the job, Memorial Hermann Health System (TX) CEO Benjamin Chu, MD resigns without providing a reason beyond his desire to pursue his “passion in health and public policy.” Charles Stokes, EVP and COO, has been named interim CEO.

University of Toledo Medical Center’s multispecialty physician group (OH) rolls out PatientKeeper’s Charge Capture technology to streamline billing at UTMC and affiliated SNFs.

Technology

Health Catalyst develops new technology to help providers better understand costs of care as they relate to patient outcomes.

Apple is reportedly working with digital health startup Health Gorilla in its efforts to turn the iPhone into a personal health data storage device. CNBC reports they are working to add integration points that will allow iOS to import results from hospitals and lab-testing companies like Quest Diagnostic and LabCorp.

Torrance Memorial Medical Center (CA) notifies patients of an April email breach that may have exposed personal information. Hospital officials have hired a third-party forensics firm to assess the scope and impact of the phishing attack.

Daniel Devereux, a homeless computer hacker in the UK known as His Royal Gingerness, is jailed for his 2015 attacks on the Norfolk and Norwich University Hospital and Norwich International Airport.

Thanks to a proactive encryption strategy, Waverly Health Center (IA) experiences little to no disturbance from a June ransomware attack.

Government and Politics

Michigan Lt. State Governor Brian Calley gathers with Henry Ford Health System and Appriss Health representatives to announce $2.1 million in funding to connect the Michigan Automated Prescription System with provider EHRs across the state. Calley hopes the integration, which will be aided by Appriss technology, will increase physician use of the PDMP from 28 to 80 percent.

The Office of the Chief Actuary of CMS forecasts a 13 million reduction in insured patients by 2026 if AHCA is passed, 10 million less than the CBO’s prediction. Reuters reports Senate Republicans will unveil their version of the bill on Thursday.

CMS releases the 2018 Quality Payment Program Proposed Rule. Health IT-related highlights of the 26-page summary include continuing to allow providers to use 2014 certified EHRs, and offering bonus points for using 2015 technology exclusively.

Innovation and Research

A West survey on patient experience finds that shorter wait times, upfront pricing, more communication options, and not feeling rushed during appointments are key to their satisfaction with providers. Nearly 80 percent claim they won’t hesitate to fire doctors that don’t meet their expectations.

Other

Australia makes genome sequencing available to patients for $6,000 through Genome One and the Garvan Institute in Sydney. Should demand increase, the Australian Genomic Healthcare Alliance may look for a way to fund testing through the country’s Medicare program.

Babies in China, on the other hand, can have their genome sequenced for the bargain price of $1,500. Earlier this month, Boston-based DNA sequencing company Veritas Genetics – a spinoff of Harvard’s Personal Genome Project – launched full genome sequencing via MyBabyGenome. Its sequencing report addresses 950 inherited diseases, 200 genes connected to drug reactions, and 100 physical traits the child is likely to have.

Sponsor Updates

Besler Consulting releases a new podcast, “Working with the first CJR reconciliation report.”

Apple is reportedly working with digital health startup Health Gorilla in its efforts to turn the iPhone into a personal health data storage device. Apple and Health Gorilla are working together to add integration points that will allow iOS to import results from hospitals and lab-testing companies like Quest Diagnostic and LabCorp.

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